HomeMy WebLinkAbout20102814.tiff / COLORADO DEPARTMENT OF MILITARY AND VETERANS AFFAIRS
COUNTY VETERANS SERVICE OFFICERS - MONTHLY REPORT AND CERTIFICATION OF PAY
COUNTY of Weld Month of October 2010
SECTION I: GENERAL INFORMATION
Telephone Calls 195- Correspondence Received ,;'� ' `t- 415' is 'u
Office (Public Contacts) 189 • ,Correspondence Written 23
Home Visits 0- Information and Referral/Inquiries . : 52 -
Outreach Visits (i.e. NH...) 1- Other(i.e: VCAA Notice Response)
Community Events/Forums 0- _ State Benefit(s) —
'Request for Medals 1. Request for Military Records &Corrections
Operation Recognition Q SF-180 12
DD 149 1
Request for Medical Treatment Records , DO 293 •
R8•
21-4142 1 10 NA 13075 0 _
Other( ) 0
SECTON II: NEW CLAIMS INITIATED
[Provide number of new claims initiated for current reporting month]
Appointed Representative: Death Pension/Widows Pension
21-22 CVA 1 21-534 6
21-22 Other 1 w/Accrued Benefits , 0
Claims for,SC Entitlement: Request for VA Healthcare
21-526 (SC - New/) 5 10-10 EZ 12
21-4138 (SC - Informal Claim) 0 10-10 EZ-R •
2 _ 8
21-4138 (SC - New Issue) 1 _ 1 50 83 0
21-4138 (SC - Reopen) 1 10-10d (CHAMPVA- Dependents) 0
21-4138 (SC - Increase) 7 — 10-7959a (CHAMPVA) 0
21-4138 (SC -Secondary./wggravation) ' 0 10-7959C (CHAMPVA-Insurance Cert 0
21-4138 (SC -Reinstatement) 0_ -
21-4138 (SC wl IU) 0 Vocational Rehabilitation
21-8940 (IU) 2 _ 28-1900 CH 31 1
21-4192 (IU-Employer) 0 28-1900 (Independent Living Program) _ 0
21-4138 (SMC) _ 0
21-686c • 0- Educational Assistance Programs
MGIB CH 30 0
Non Service Connected Pension: VEAP CH 32 0
21-526 r 4 - VN Era GI CH 34 0
21-527 0 22-5490 • CH 35 0
�686c
s 2 Sel Reservist NG CH 1607 0
21-526/527 w/A&A 5 ,21-674 0
,21-4138 (Reinstatement) 0-
EVR(Any) _---r—
— Miscellaneous Claims
21-8416 0 21-8678 (Clothing Allowance) 0 -
5655 1 21-4502 (Auto Grant/Adaptive Equipment) _ 0
26-4555 (Housing Grant) 0
Request for Waivers/Compromise: 10-0103 (HISA Grant) 0
21-4138 1 Medicaid Application Assistance 4 _
5655 (FSR) I- SSA Application Assistance - 0
Other(Specify) 0
Dependent Indemnity Compensation(DIC) Other(Specify) 0
21-534 7 Other (Specify) - II
w/Accrued Benefits 0 ///2 ('CD/
/ CVA-26(Revisers 4/ n '
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SECTION II (Continued):
. Burial Allowance - Claims for Insurance
21-530 _ _l____ 29-357 0-
40-1330 1 29-4364 0_
21-2008 0 29-336 (Designation of Beneficiary) 0
21-4125 (Claim for Lump Sum Payment) O.
VA Home Loan
26-1800 7 Requests w/VTF (Grant),#Vets Assisted
26-1817 0 Rental Assistance 0-
Utilities Assistance 0
Homeless Veterans Claims Filed Prescription Assistance /Other Medical ---ii-
SC 0 Food 0
NSC 0 Transportation —D
Clothing 0.
Incarcerated Veterans Other 0
21-4193 Release/Reinstatement 0 r
21-4138 (Apportionment) 0
Appeals DRO Election
NOD 0 Review 0
• VA 9 0 Hearing 1
SECTION III: CERTIFICATION BY COUNTY VETERANS SERVICE OFFICER
I hereby certify, the above captioned monthly report is true and accurate. I have b naid the following
amount(s) for the month of .October , 20 10 from Weld County:
•
Salary $4.310 09
Expenses None
Office SpaceCounty pays utilities in lieu of rent
Telephone $ "163:97
Office Supplies 31. 16
Travel None
Training Conference None
Other Copier 96.00
Other Internet 82.99 •
Other — postage 126.88
Total ght,811 09, + utilities
(Signature of Coun veterans Service Off er) (Date)
Dorothy- Strong, -Veterans Counselor for
Pat Persichino, Veterans Service Officer
SECTION IV: CERTIFICATION BY COUNTY COMMISSIONER OR DESIGNEE
In accordanc e.
with CRS 28-5-707, I hereby certify the accuracy of the Repo A-2 revised 9/ /2"
<Coun (Tif �Yo fin Counse
., l .
�1 '(CS Yr�(� ty
Dougjas Rade acher, Chair
eld County
NOV 2 2 2010 Date
This certification, submitted monthly, properly signed and executed, will be considered as application for the
monetary benefits to the County General Fund, in accordance with 28-5-804 (2002) Colorado Revised Statue.
This form is to be submitted by the 15th day of the following month. Mail to:
Colorado Division of Veterans Affairs
Attention: Deputy Director
• 7465 E. 1st Avenue, Suite C
Denver,CD 80230 CVA-26(Revised 9/1/2006)
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